Ask Dr. Marc: Cycle Conversions

Dear Doctor Marc,

I am in the middle of a cycle now and we’re faced with more decisions. For our first, we did 9 rounds of IUI (started with just clomid, progressed to combo clomid and follistim, then only follistim to conceive).

We’re on our third round of IUIs this time around (on max dose of follistim) and are considering converting this round to an IVF cycle due to the risk of hyperstimulation. Just yesterday I had 6 follicles in the 9-11 mm range and today we had 19 in the 11-13 range! We’ve never done IVF so I’m slightly nervous about the conversion, especially the down time after retrieval and transfer with chasing another little one around.

Here are a few more details: estrogen in low 900s, can’t convert cycle because our clinic isn’t in an IVF cycle at the moment, monitoring again tomorrow morning, lower follistim dosage to 25 iu for tonight and possibly take Luperon tomorrow depending on lab work. Doc doesn’t think we have an overly average number of fully mature follicles but we are concerned about high order multiples and other risks (hyper-stimulation, etc).

Is conversion a good option?

L.

Dear L.,

Converting an IUI cycle to IVF is a very reasonable option in certain circumstances.  In fact, I can think of a couple patients, in particular, who have benefited greatly from this option.  In addition, the fact that you have completed so many IUIs indicates to me that it is probably time to move on to IVF anyway.  With that being said, there are a few factors you would want to be in order before converting up to IVF.

1. Your lead follicles should not be too big:  If the largest follicles are too big, the smaller follicles may not have time to catch up.  This could result in a lower number of eggs for IVF and potentially could affect your chance for success.  If there are indeed 19 follicles in the 11-13mm range, this does not seem to be a problem.

2. Endometrial lining:  Sometimes an IUI cycle that is converted to IVF may be a very long cycle (greater than 14 days).  Very long cycles can result in overstimulation of the endometrium, which could negatively affect your chances.   You doctor can get a sense of your lining by measuring it on ultrasound.

3. Timing: There are a multitude of variables which go into an IVF cycle.  Coordinating these variables is one of the most important jobs of an IVF center.  If your center is not prepared to coordinate an IVF cycle at this time, then you definitely want to wait until they are ready.

The bottom line is that conversion to IVF can be an excellent option, but it should only be used in properly selected patients.

Good luck,

Doctor Marc